Minimally Invasive Direct Coronary Bypass Grafting Versus Percutaneous Coronary Intervention for Single-vessel Disease of The Proximal Left Anterior Descending Artery: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIJun-hong , ABUDOUWAILI ,  ABUDUNAIBI , MuLa-Ti

Department of Cardiac Surgery Division One, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ABUDUNAIBI, Email: nebi-boss@hotmail.com

Keywords：

Percutaneous coronary intervention (PCI); Coronary artery bypass grafting (CABG); left descending artery (LDA); minimally invasive; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160108

Video：

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Objective To systematically review the efficacy and safety of minimally invasive direct coronary artery bypass (MIDCAB) grafting versus percutaneous coronary intervention (PCI) for patients with single-vessel disease of the left anterior descending artery (LAD). Methods Databases including The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about MIDCAB versus PCI for single-vessel disease of the LAD. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs including 1 489 patients were included. The results of meta-analysis showed that: compared with the PCI group, the MIDCAB group could significantly reduce the incidence of postoperative target vessel revascularization (OR=0.20，95%CI 0.13 to 2.29，P < 0.000 01), and the incidence of main adverse cardiovascular and cerebrovascular events (MACCE) (OR=0.44, 95%CI 0.33 to 0.58, P < 0.000 01). No significant differences were found between the two groups in total case mortality (OR=1.23, 95%CI 0.83 to 1.83, P=0.31), cardiogenic death (OR=1.12, 95%CI 0.59 to 2.12, P=0.73), and the incidence of postoperative myocardial infarction (OR=2.16, 95%CI 0.83 to 5.59, P=0.11). Conclusion In reducing the incidences of postoperative target vessels again revascularization and MACCE of patients with single-vessel disease of the LAD, MIDCAB is superior to PCI. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.

Citation： LIJun-hong, ABUDOUWAILI, ABUDUNAIBI, MuLa-Ti. Minimally Invasive Direct Coronary Bypass Grafting Versus Percutaneous Coronary Intervention for Single-vessel Disease of The Proximal Left Anterior Descending Artery: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(6): 698-705. doi: 10.7507/1672-2531.20160108 Copy

1.	Kolh P, Wijns W, Danchin N, et al. Guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2010, 38(3): S1-52.
2.	Kapoor JR, Gienger AL, Ardehali R, et al. Isolated disease of the proximal left anterior descending artery comparing the effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. JACC Cardiovasc Interv, 2008, 1(5): 483-491.
3.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org.
4.	Cisowski M, Drzewiecki J, Drzewiecka-Gerber A, et al. Primary stenting versus MIDCAB: preliminary report comparision of two methods of revascularization in single left anterior descending coronary artery stenosis. Ann Thorac Surg, 2002, 74(4): S1334-1339.
5.	Diegeler A, Thiele H, Falk V. Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery. N Engl J Med, 2002, 347(8): 561-566.
6.	Drenth DJ, Veeger NJGM, Winter JB, et al. A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade stenosis in the proximal left anterior descending coronary artery: three-year follow-up. J Am Coll Cardiol, 2002, 40(11): 1955-1960.
7.	Reeves BC, Angelini GD, Bryan AJ, et al. A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery. Health Technol Assess, 2004, 8(16): 1-43.
8.	Hong SJ, Lim DS, Seo HS, et al. Percutaneous coronary intervention with drug-eluting stent implantation vs minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. Catheter Cardiovasc Interv, 2005, 64(1): 75-81.
9.	Kim JW, Lim DS, Sun K, et al. Stenting or MIDCAB using ministernotomy for revascularization of proximal left anterior descending artery. Int J Cardiol, 2005, 99(3): 437-441.
10.	Thiele H, Oettel S, Jacobs S, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: a 5-year follow-up. Circulation, 2005, 112(22): 3445-3450.
11.	Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol, 2009, 53(25): 2324-2331.
12.	Blazek S, Holzhey D, Jungert C, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2013, 6(1): 20-26.
13.	Blazek S, Rossbach C, Borger MA, et al. Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. ACC Cardiovasc Interv, 2015, 8(1): 30-38.
14.	Boudriot E, Thiele H, Walther T, et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol, 2011, 57(5): 538-545.
15.	Yang JH, Gwon HC, Cho SJ, et al. Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease. Ann Thorac Surg, 2008, 85(1): 65-70.
16.	Tarantini G, Ramondo A, Napodano M. PCI versus CABG for multivessel coronary disease in Diabetics. Catheter Cardiovasc Intery, 2009, 73(1): 50-58.
17.	Banning AP, Westabys, Morice MC, et al. Diabetic and nondiabetic Patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol, 2010, 55(11): 1067-1075.
18.	Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation, 2010, 121(6): 2645-2653.
19.	Park SJ, Kim YH, Park DW, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med, 2011, 364(18): 1718-1727.
20.	李俊红, 艾克拜尔, 木拉提, 等. 冠状动脉旁路移植术治疗无保护左主干病变疗效及安全性系统评价. 中国循证医学杂志, 2013, 13(9): 1096-1101.
21.	李俊红, 艾克拜尔, Kamran Y Inamdar, 等. 冠状动脉旁路移植术治疗冠心病合并糖尿病患者有效性和安全性的Meta分析. 中国循证医学杂志, 2012, 12(9): 1116-1121.
22.	Mishra YK, Collison SP, Malhotra R, et al. Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2008, 135(3): 527-532.
23.	Blazek S, Rossbach C, Borger MA, Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2015, 8(1): 30-38.
24.	Sa MP, Ferraz PE, Escobar RR, et al. Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13524 patients from randomized trials. Rev Bras Cir Cardiovasc, 2013, 27(4): 631-641.
25.	Patel AJ, Yates MT, Soppa GK. What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary Intervention. Interact Cardiovasc Thorac Surg, 2014, 19(1): 144-148.
26.	Reser D, Hemelrijck Mv, Pavicevic J. Mid-Term Outcomes of Minimally Invasive Direct Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg, 2015, 63(4): 313-318.
27.	Stanbridge RD, Hadjinikolaou LK. Technical adjuncts in beating heart surgery comparison of MIDCAB to off-pump sternotomy: a meta-analysis. Eur J Cardiothorac Surg, 1999, 16(2): S24-33.
28.	张继倬, 公兵, 杨秀滨. 对比经皮冠状动脉介入治疗和小切口直接冠状动脉旁路移植术治疗前降支基底部狭窄的临床疗效的荟萃分析. 中国医科大学学报, 2014, (5): 401-406.
29.	Mariani MA, Boonstra PW, Grandjean JG, et al. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery. J Thorac Cardiovasc Surg, 1997, 114(3): 434-439.
30.	Ben-Gal Y, Mohr R, Braunstein R, et al. Revascularization of left anterior descending artery with drug-eluting stents: comparison with minimally invasive direct coronary artery bypass surgery. Ann Thorac Surg, 2006, 82(6): 2067-2071.
31.	Etienne PY, D’Hoore W, Papadatos S, et al. Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis. Eur J Cardiothorac Surg, 2013, 44(5): 884-890.
32.	Iakovou I, Dangas G, Mehran R, et al. Minimally invasive direct coronary artery bypass (MIDCAB) versus coronary artery stenting for elective revascularization of the left anteriordescending artery. Am J Cardiol, 2002, 90(8): 885-887.
33.	Shirai K, Lansky AJ, Mehran R, et al. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease. Am J Cardiol, 2004, 93(8): 959-962.
34.	Kubo S, Kadota K, Shimada T, et al. Seven-year clinical outcomes of unprotected left main coronary artery stenting with drug-eluting stent and bare-metal stent. Circ, 2013, 77(10): 2497-2504.
35.	Geng DF, Meng Z, Yan HY, et al. Bare-metal stent versus drug-eluting stent in large coronary arteries: meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv, 2013, 81(7): 1087-1094.

1. Kolh P, Wijns W, Danchin N, et al. Guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2010, 38(3): S1-52.
2. Kapoor JR, Gienger AL, Ardehali R, et al. Isolated disease of the proximal left anterior descending artery comparing the effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. JACC Cardiovasc Interv, 2008, 1(5): 483-491.
3. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org.
4. Cisowski M, Drzewiecki J, Drzewiecka-Gerber A, et al. Primary stenting versus MIDCAB: preliminary report comparision of two methods of revascularization in single left anterior descending coronary artery stenosis. Ann Thorac Surg, 2002, 74(4): S1334-1339.
5. Diegeler A, Thiele H, Falk V. Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery. N Engl J Med, 2002, 347(8): 561-566.
6. Drenth DJ, Veeger NJGM, Winter JB, et al. A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade stenosis in the proximal left anterior descending coronary artery: three-year follow-up. J Am Coll Cardiol, 2002, 40(11): 1955-1960.
7. Reeves BC, Angelini GD, Bryan AJ, et al. A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery. Health Technol Assess, 2004, 8(16): 1-43.
8. Hong SJ, Lim DS, Seo HS, et al. Percutaneous coronary intervention with drug-eluting stent implantation vs minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. Catheter Cardiovasc Interv, 2005, 64(1): 75-81.
9. Kim JW, Lim DS, Sun K, et al. Stenting or MIDCAB using ministernotomy for revascularization of proximal left anterior descending artery. Int J Cardiol, 2005, 99(3): 437-441.
10. Thiele H, Oettel S, Jacobs S, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: a 5-year follow-up. Circulation, 2005, 112(22): 3445-3450.
11. Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol, 2009, 53(25): 2324-2331.
12. Blazek S, Holzhey D, Jungert C, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2013, 6(1): 20-26.
13. Blazek S, Rossbach C, Borger MA, et al. Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. ACC Cardiovasc Interv, 2015, 8(1): 30-38.
14. Boudriot E, Thiele H, Walther T, et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol, 2011, 57(5): 538-545.
15. Yang JH, Gwon HC, Cho SJ, et al. Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease. Ann Thorac Surg, 2008, 85(1): 65-70.
16. Tarantini G, Ramondo A, Napodano M. PCI versus CABG for multivessel coronary disease in Diabetics. Catheter Cardiovasc Intery, 2009, 73(1): 50-58.
17. Banning AP, Westabys, Morice MC, et al. Diabetic and nondiabetic Patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol, 2010, 55(11): 1067-1075.
18. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation, 2010, 121(6): 2645-2653.
19. Park SJ, Kim YH, Park DW, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med, 2011, 364(18): 1718-1727.
20. 李俊红, 艾克拜尔, 木拉提, 等. 冠状动脉旁路移植术治疗无保护左主干病变疗效及安全性系统评价. 中国循证医学杂志, 2013, 13(9): 1096-1101.
21. 李俊红, 艾克拜尔, Kamran Y Inamdar, 等. 冠状动脉旁路移植术治疗冠心病合并糖尿病患者有效性和安全性的Meta分析. 中国循证医学杂志, 2012, 12(9): 1116-1121.
22. Mishra YK, Collison SP, Malhotra R, et al. Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2008, 135(3): 527-532.
23. Blazek S, Rossbach C, Borger MA, Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2015, 8(1): 30-38.
24. Sa MP, Ferraz PE, Escobar RR, et al. Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13524 patients from randomized trials. Rev Bras Cir Cardiovasc, 2013, 27(4): 631-641.
25. Patel AJ, Yates MT, Soppa GK. What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary Intervention. Interact Cardiovasc Thorac Surg, 2014, 19(1): 144-148.
26. Reser D, Hemelrijck Mv, Pavicevic J. Mid-Term Outcomes of Minimally Invasive Direct Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg, 2015, 63(4): 313-318.
27. Stanbridge RD, Hadjinikolaou LK. Technical adjuncts in beating heart surgery comparison of MIDCAB to off-pump sternotomy: a meta-analysis. Eur J Cardiothorac Surg, 1999, 16(2): S24-33.
28. 张继倬, 公兵, 杨秀滨. 对比经皮冠状动脉介入治疗和小切口直接冠状动脉旁路移植术治疗前降支基底部狭窄的临床疗效的荟萃分析. 中国医科大学学报, 2014, (5): 401-406.
29. Mariani MA, Boonstra PW, Grandjean JG, et al. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery. J Thorac Cardiovasc Surg, 1997, 114(3): 434-439.
30. Ben-Gal Y, Mohr R, Braunstein R, et al. Revascularization of left anterior descending artery with drug-eluting stents: comparison with minimally invasive direct coronary artery bypass surgery. Ann Thorac Surg, 2006, 82(6): 2067-2071.
31. Etienne PY, D’Hoore W, Papadatos S, et al. Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis. Eur J Cardiothorac Surg, 2013, 44(5): 884-890.
32. Iakovou I, Dangas G, Mehran R, et al. Minimally invasive direct coronary artery bypass (MIDCAB) versus coronary artery stenting for elective revascularization of the left anteriordescending artery. Am J Cardiol, 2002, 90(8): 885-887.
33. Shirai K, Lansky AJ, Mehran R, et al. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease. Am J Cardiol, 2004, 93(8): 959-962.
34. Kubo S, Kadota K, Shimada T, et al. Seven-year clinical outcomes of unprotected left main coronary artery stenting with drug-eluting stent and bare-metal stent. Circ, 2013, 77(10): 2497-2504.
35. Geng DF, Meng Z, Yan HY, et al. Bare-metal stent versus drug-eluting stent in large coronary arteries: meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv, 2013, 81(7): 1087-1094.

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Chinese Journal of Evidence-Based Medicine

Minimally Invasive Direct Coronary Bypass Grafting Versus Percutaneous Coronary Intervention for Single-vessel Disease of The Proximal Left Anterior Descending Artery: A Meta-analysis

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